Prospective randomized evaluation of intraocular lens centration with scanned capsule vs limbus-based capsulotomy for femtosecond laser-assisted cataract surgery

Session Details

Session Title: Femtolaser-Assisted Cataract Surgery (FLACS) I

Session Date/Time: Sunday 08/10/2017 | 08:00-10:00

Paper Time: 08:30

Venue: Room 3.6

First Author: : S.Basti USA

Co Author(s): :    R. Talati   R. Dalal   D. Grewa   S. Basti           

Abstract Details

Purpose:

The reported benefits of femtosecond cataract surgery include greater precision of the capsulotomy and better intraocular lens (IOL) and anterior capsule overlap, and hence better IOL positioning. However, to the best of our knowledge, it has not been shown whether these benefits are influenced by the method of capsulotomy centration, which can vary based on the laser platform and surgeon selection. This study sought to determine the influence of the centration method of laser capsulotomy on IOL centration and IOL-capsulotomy overlap. Additionally, longitudinal changes in centration and overlap between the intraoperative period, one month, and one year following surgery were evaluated.

Setting:

This prospective, randomized study was performed by a single surgeon at a large academic center. The study was conducted in compliance with the Declaration of Helsinki and with approval from the governing institutional review board. A written informed consent was obtained prior to surgery from every patient.

Methods:

50 eyes from 33 patients undergoing femtosecond laser-assisted cataract surgery (CATALYS® Precision Laser System; Abbott Medical Optics, Illinois, USA) were assigned to either the scanned capsule (n=25) or limbus-based (n=25) method of centration. Digital retroillumination photographs were obtained intraoperatively, 1 month, and 1 year postoperatively. Circularity index, vector decentration, total decentration, and rim-to-optic overlap were determined using Photoshop CS6 (Adobe Systems Inc, California, USA). A benchmark value of 1.0 was used for circularity and overlap to indicate a theoretically perfect circle and perfect capsular rim-to-optic overlap, respectively.

Results:

Mean circularity index between scanned capsule and limbus-based capsulotomies was not significantly different intraoperatively (p=0.57), at one month (p=0.44) or one year (p=0.44). IOL decentration from the pupillary center was not significantly different between scanned capsule and limbus-based eyes intraoperatively (p=0.58) or at 1 month (p=0.87). At 1 year, scanned capsule trended towards less total decentration (0.04 mm) compared to limbus-based eyes (0.36 mm). Scanned capsule eyes achieved better overlap intraoperatively (p=0.05), at one month (p=0.01) and one year (p=0.01). A trend towards greater visual acuity was detected at one year in scanned capsule (20/25) compared to limbus-based eyes (20/40).

Conclusions:

Scanned capsule capsulotomies achieves superior IOL decentration, IOL-capsulotomy overlap and visual outcomes compared to limbus-based capsulotomies over the course of one year. Intergroup differences become more pronounced over the course of one year following surgery, suggesting a shift in both capsulotomy and IOL positions.

Financial Disclosure:

research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented